Fully Insured Health Plans
Assumption of Risk - Insurance carriers assume the risk of paying medical claims and charges
Experience Base - Insurance carriers pool the experience of its clients and base the premiums on spreading the risk.
Law Compliance - Subject to numerous state laws requiring a wide range of benefits.
Employer Liability - Limited to the premium payments.
Minimum Premium Plans
Assumption of Risk - The Employer and the insurance carrier share the risk The employer pays claims up to the Aggregate Stop Loss (usually set at 110% or 120% of expected claims)
Experience Base - Premiums are based on own employees' experience and pooled experience. There is weighting of these two components to achieve credible rates.
Law Compliance - Subject to numerous state laws requiring a wide range of benefits.
Employer Liability - Limited to the Maximum Premiums and Terminal Liability
Partially Self Funded Health Plans
Assumption of Risk - Employer assumes some or all of the risk for the health benefit plan. To avoid exposure to catastrophic or unexpected claims, the employer adds stop loss insurance
SPECIFIC - limits the employer's financial risk arising from a single claim (determined at the outset of the plan)
AGGREGATE - limits the total financial risk on claims for the total group in a given year (usually set at 125% of expected claims)
Experience Base - Employer pays premiums based on own employees' experience.
Law Compliance - Subject to only federal regulations. Governed by the Employee Retirement Income Security Act of 1974(ERISA). Allows the flexibility to design the health benefit plan to more accurately reflect the needs of the specific group.
Employer Liability - Limited to the Fixed Costs and levels up to the Specific and Aggregate Stop Loss
